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11110087 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20900 HOMESTEAD RD CONTRACTOR:MONTEREY PERMIT NO: 11110087 CONSTRUCTION COMPANY OWNER'S NAME: VS II LP 88 MONTEREY-SALINAS HWY STE A DATE ISSUED: 11/17/2011 O 'S PHONE: 6509313400 SALINAS,CA 93908 PHONE Na(831)601-2659 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class Lic.q L / MECH r7RESIDENTIALr COMMERCIAL Contract ! —/ Date 1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:BLDG 73,UNIT D,REMODEL R-2 KITCHEN(50 SF),ADD (commencing with Section 7000)of Division 3 of the Business&Professions NEW WASHER&DRYER(10 SF),AND NEW A/C UNIT Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 1 have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$20000 permit is issued. APPLICANT CERTIFICATION APN Number:32609072.00 Occupancy Type: I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-paint source regulations er the Cupertino Municipal Code,Section 9.18. ._ y' Z_ �f _ q�.����� by _ Signature � Date1[�[s9�t'-'*-� Issued Date ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the 1 have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Cade,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should 1 store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District 1 will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Owne or act-oziz forthwith comply with such provisions or this permit shall be deemed revoked. Date: CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save in rfy and keep harmless the City of Cupertino against liabilities,judgmems, Lender's Address a td expenses which may accrue against said City in consequence of the gr ng of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional • CITY OF CUPERTINO 8 ITEMS OF 32 PERMIT RECEIPT OPERATOR: TraciC COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32609072 .00 DATE ISSUED. . . . . . . : 11/17/2011 RECEIPT #. . . . . . . . . : BS000015349 REFERENCE ID # . . . : 11110087 SITE ADDRESS . . . . . : 20900 HOMESTEAD RD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : VS II LP ADDRESS . . . . . . . . . . : 20900 HOMESTEAD RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : RICHARD REGA CONTRACTOR . . . . . . . : BEN REGA LIC # 32275 COMPANY . . . . . . . . . . : MONTEREY CONSTRUCTION COMPANY ADDRESS . . . . . . . . . . : 88 MONTEREY-SALINAS HWY STE A CITY/STATE/ZIP . . . : SALINAS, CA 93908 TELEPHONE . . . . . . . . : (831) 601-2659 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1.00 41.00 0 .00 41. 00 0. 00 12APPLOTHE NO OF APPLIAN 2 . 00 130.00 0 . 00 130 . 00 0. 00 1BCBSC VALUATION 20, 000.00 1 .00 0 . 00 1. 00 0.00 1BREMAIRHA NO.UNITS 1.00 65.00 0 .00 65.00 0. 00 1BSEISMICR VALUATION 20, 000.00 2 .00 0 .00 2 . 00 0.00 1MPERMITFE FLAT RATE 1.00 44 .00 0 . 00 44 . 00 0 .00 1REMRESKIT SQ FEET 50.00 588.00 0 .00 588 . 00 0.00 1TRAVDOC FLAT RATE 1. 00 44 . 00 0.00 44 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 915.00 0 .00 915. 00 0.00 • CITY OF CUPERTINO ��\\ FEE ESTIMATOR-BUILDING DIVISION • allADDRESS: 20900 homestead rd DATE: 11115/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$20,000 "PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration I Repair PRIMARY SFD or Duplex PENTAMATION 1R3SFDREM USE: PERMIT TYPE: WORK remodel r-2 kitchen add new W/D and new A/C unit. SCOPE f eLI'1. .': `�13n �Y', .F'tt . � Mech.Plan Check 0.0 hrs $0.00 I'huub l"I'm Ch",rCEk•r.flea Che,k Mech.Permit Fee: IMPERMIT 1'Lonb, Prrnur I7r. f7rr i4 rwi[fer' • Other Mech. Insp. 0.0 hrs $44.00 t>dn; Nnudr b,.p Fi,v nnp- ;Vu.ar. lmj'. P"". Plunrh Iu.+7t 1'm" lJo hnp, l'rr NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the prelimina Information available and are only an estimate. Contact the De t or addn't info. FEE ITEMS (Fee Resolution 11-053 EB 7,1111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0:00 50 s.f. Remodel,Kitchen(<=300 sO Suppl. PC Fee: Q Reg. Q OT F0,0Thrs $0.00 $588.00 IREMRESKIT PME Plan Check: $0.00 F T-1 # Mechanical Permit Fee: $0.00 $65.00 IBREMAIR A/C Units(<=1OK cfm) Suppl. Insp. Fee:Q Reg. Q OT 0,0 1 hrs $0.00 2 # Mechanical PME Unit Fee: $0.00 $130.00 IBAPPLOT Other Appliance/Equip PME Permit Fee: $44.00 C'onstruviiun Ter.c Administrative Fee: IADMIN $41.00 O Work Without Permit? O Yes 0 No $0.00 E) Advanced Planning Fec: $0.00 Select a Non-Residential Travel Documentation Fee: ITRA vDOC $44.00 Building or Structure 0 A Strong Motion Fee: IBSEISMiCR $2.00 Select an Administrative Item • Blde Stds Commission Fee: IBCBSC $1.00 r ` ''SUBTOTALS:' $132.00 $783.00 TOTALFEE: $915.00 Revised: 10/01/2011 11/15/2011 14 : 53 (FAX) P. 003/005 CONSTRUCTION PERMIT APPLICATION • �„ COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO,CA 95014.3255 CUPERTINa (408)777-3228• FAX(408)777-3333•buildingAcupertino ora ❑NEW CONS'I'RUCT10N ❑ ADDITION ❑ ALTERATION Ti/ ❑ REVISION/DEFERRED ORIGINAL PERMIT# raaucrnoDRrss UItS APIJa jl7 20 00 \�Cymes\ eacA 2�. P�1d 1?� It S-->_ �[/ l J OWNER NAMB : &MAIL GOOADDRESS S CRY,STATE,ZIP FAX 1YL.Sk-. JI 1SC� jC�c1 Y`Y'� ea CONTACT NAME PHONE H•MAIL \<-Q G_ ` ;}I uSS•" Gt'J\ %i-ho\i r Li-r.( CC.�vi-<uc.•V:w.w... STREET ADDRESS CITY,STATE. ZIP FAX YY�clY1'C,r _`..'>c.E:nc.S Hw 31 • " G3 11 OWNER ❑ OwNOt-DMOER ❑ OWNERAORNT 9CONTRACIOR ❑CONTAACPORA ENI' ❑ ARCIipECT ❑FNOINeeR ❑ DCVELOPER ❑TENANT row;ACTOR NAME LICENSE NUMBER LICENS YPE BUS.LIC N t� 3iz1s t'YYCYI„\COMPANY NAME 2l FAX L E-MAIL `a-3�-) C.c:n -F-t�c.+l�cy.n -M1-�n).�c. m�I t:t..-. i-c-u<h:.n. Lo•••. 'a5 '1�'.Qln STREET ADDRESS �Sw CITY,STATE,ZIP V=N 4&'C 0; C-L!"1 r-10Jci[J�{ yss' -1CD'� ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LICA COMPANY NAME B-MAIL PAX STREET ADDRESS CITY,STATE.ZIP PHONE DESCRIPTION OF Wong - A-Yn\1 r ra V. r er cJc 2 -1':•r� 6eA- 10 s ry,c� ,A! r EXISTING USE PROPOSED USE CONSnt TYPE fiSTORIES I 'di .111 ,rypl§��.f l.�lih. ' ' '(ISI)SR' drib �77777777 ExLSTG New PIAOR n[eso TOTALI, n tl rtl tl II Y�I.It,I AREA AREA ARTA NETAREA b), Ii, IJJ �� IIIIO!III,{ILIt UJ,II;i,IJ BATHROOM KDCHON rtemODELARen r �11 JI.J��I�wlluJ I L,� Ii.li 1 II RAIODBLARG Rp.10DCLA1taA AO t't T �IPY ! Q ISI�'N [ 1 PORCH AREA DECKAREA TGTALDECKNOROI AREA GARAGE nRPA: ❑ DETACH 1 it f �t I I I: ' II '� N ATTACH �,�J 70I ,l JJ- d�l F)IIY�Igl)ti'i�IJ�ilijkfl(,II I ` II! Y nW6LNNO11Nlia: INANLCONI UNIT YL9 6ECONn bTORY j y,f tl t I ❑ ❑Yes �I MI 5• I"I nYlhlJ I acrxo Aaoeor No Aomnosr NO I "I I � `IQ� �,�'�.FiIYIlflJS IRI II'�Nf, t PNX�P1 �h +t udl I':, )I b8 H•I. r /'Mn,it 11.,11 Ih 1 FLANNIDGTON ❑No nTBY,IM1WD7NCOPYOP PLVINCR'N NAMLL ! IIM' M ) LIJ J Y V 4 PUNNOD APPLY ❑No PUN- MPRWALLHIT2R I F y�. ,II ) �6 i .WoRl d"T' `IlJ llr�/1LrVA)rt1ATON By my signature below,I certify to each of the following: I srn the properly Owner or authorized agent to oat on the property owner's behalf. 1 have read[itis application and tIt information 1 hnvo pr vi ed is correct. I have read the Description Of Work and verify it is accurate, 1 agree to comply with all applicable local Ordinanera end slate laws relating t i g conslmraion. I authorize reprmenlativm of Cupertino to enter the above-'de uned�p operty for inspection purposes. Signature of Applicant/Agent Date: 1"\ T-- SUPPLEMENTAL SUPPLEMENTAL INFORMATION REQ UIRED NI IL , ;T� t'II KP11yP If 11,l1 til r: ROUTING$LIP _New SFD or Multifanuly dwellings: Apply for demolition permit for exisbing building(s). Demolition permit is required prior to issuance of building 1 + P I aP �p'i GI p `�iaf.�T}uulLmtjc t LANlnr,vlHw permit for new building. I Commercial Bldgs: Provide B completed Hazardous Materials Disclosure I II a Nrylr+tslPr,AIJJarYis 'v �111�EI 4 ( ,FI q,j3,tftl V 1 form If any Hazardous Materials are being used as part of this project III`)'"It`©i1 ul)paw woBNs'J CGpyofPlarming Approval Letter or Meeting with Planning pd or to " � J1 � ,TN' '�iiJG'l� Y 4a�'I submittal of Building Permit application. , Y� !!! 4)'iAAys wqH DISTRICT pp{� {�, I NJI I��l'.tllY7Nli�1 I L:F. : Iv I J „LII,':kkj1,S: ,I: bud )�la•Hn inonMVNTA�IiiHgAli7I BldgApp 211//,doc revised l/3/16/1/